Table 4
Author, date and countryPatient groupStudy type (level of evidence)OutcomesKey resultsStudy weaknesses
Swischuck L et al, 2000, USA984 questionnaires submitted to paediatric radiologists (432 respondents) to determine whether odontoid views were included in the imaging protocols and how often odontoid fractures were missed on lateral views and detected on odontoid views in children under 5 yearsSurveyConcept that the odontoid view might not be necessary in children under 5Of the 432 respondents, 161 (37%) indicated that an open mouth odontoid view was not routinely included in their imaging protocolOnly 44% of radiologists responded
Recollection of a missed fracture is not a reliable method of data collection
Of the 271 respondents who routinely use the open mouth odontoid view, 122 (45%) would request a CT if this view was too difficult to obtainEmergency physicians, not radiologists are the cohort of doctors who are actually most likely to recollect missed fractures such as these
28 of the 432 respondents (7%) reported missing a total of 46 fractures on the lateral view that were detected on the odontoid view
Buhs C et al, 2000, USAMulti-institutional review of all paediatric patients in the 0–16 age group with a documented cervical spine injury during a 10 year period from 1987–1997 at 4 hospitals. 
 51 children with cervical spine injury were identified from the medical recordsRetrospective cohort studyIdentification of a cervical fracture on odontoid peg view alone.In no child in the 0–8 year old group was the odontoid peg view useful to make a diagnosis of fracture. Also in 63% of these children, the film was of such poor quality that the dens could not be evaluatedTotal number of children with cervical injury was only 51
This study looks retrospectively at positive fractures only, no cohort of odontoid views was analysed, thus limiting greatly the utility of this study
In the 9–16 year-old group only 1 of 36 children (3%) was the open mouth view the diagnostic view (a Type III odontoid injury)
American Association of Neurological Surgeons and the Congress of Neurological Surgeons, 2002, USASearch of Medline (1966–2001) in the following subject headings: “spinal injuries” and “child” were reviewed with “cervical vertebrae”, “spinal injuries” and “child”. Altogether, 58 relevant articles were identifiedSystematic reviewGuidelines for the management of acute cervical spine and spinal cord injuriesInsufficient evidence to support diagnostic standards however the following are recommended:Search strategy is not fully described in this paper
 Note authors came to their recommendations largely on the two other studies summarised above
In children <9 years of age who have experienced trauma and are non-conversant, or have neurological deficit, an altered mental status, neck pain, or a painful distracting injury, are intoxicated, or have unexplained hypotension it is recommended that anteroposterior and lateral cervical spine radiographs be obtained.